PULSATILE KIDNEY PERFUSION FOR EVALUATION OF HIGH-RISK KIDNEY DONORS SAFELY EXPANDS THE DONOR POOL

Pulsatile preservation of cadaveric kidney allografts allows effective organ preservation and the opportunity to obtain information about th e quality of the organ during storage. The use of information obtained by measuring FLOW (ml/min) and renal resistance (mean perfusion press ure/FLOW(ml/min)) while kidneys are undergoing pulsatile perfusion off ers quantitative data to determine suitability of an organ for transpl ant. This may be more accurate than the combination of demographic var iables with past and current medical information that has been traditi onally used to evaluate donor suitability. We have evaluated 82 kidney s that received a period of pulsatile preservation at our institution. Kidneys were from consecutive donors age greater-than-or-equal-to 42 years and were stratified into three high risk groups: donor age great er-than-or-equal-to 60 (48%), the presence of hypertension (52%), and IMPORT kidney (48%). All IMPORT kidneys were obtained through UNOS aft er the local center considered them unacceptable for transplant and no ne were 6-antigen match organs. Kidneys were discarded if they failed to have a FLOW greater-than-or-equal-to 70 ml/min or RR less-than-or-e qual-to 0.4. Twelve kidneys (15%) failed to meet these criteria and we re discarded. All 12 kidneys were from donors age greater-than-or-equa l-to 60 (p = 0.002). The average FLOW and RR of transplanted kidneys w as 103 ml/min and 0.3283 respectively. Six of 69 (8.6%) transplanted o rgans required dialysis (ATN). No pump parameters predicted the develo pment of ATN although 5 of 6 kidneys were IMPORTs. Recipient outcome d ata, including 72-hour urine output and day 10 serum Cr, were affected by organ risk group, but these did not impact on patient care. Overal l 2-year graft survival was 82%. Two year graft survival was 25% worse in IMPORT compared to LOCAL kidneys (p = 0.0105). Multivariate analys is to determine the risk of dialysis and the risk for graft loss ident ified IMPORT kidney as the single independent variable. We conclude th at the use of pulsatile perfusion. parameters allows safe selection of kidneys from high-risk CAD donors with a ATN rate substantially below the national average without compromising patient outcome. We believe that these data demonstrate that the use of pump perfusion parameters to select organs for transplantation will allow safe utilization of t he marginal CAD donor, especially as programs develop ''non-heart beat ing donor'' protocols.